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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Capsule-deficient Cryptococcus neoformans (CN-CD) infection is very rare. The authors recently experienced the case of CN-CD infection with the complication of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in a 83 year old woman. She was admitted to our hospital with the complaints of fever and general fatigue on June 10, 1987. At the time of admission, there were no abnormal findings except a mildly lowered consciousness level on physical examination, there were no abnormal neurological finding nor meningeal signs. Laboratory data revealed a mild leukocytosis and hyponatremia. Chest X-P showed a few small nodular shadows scattered in both lungs. Antibiotics therapy was of no help and hyponatremia became worse. Then with the suspicion of SIADH, Demeclocycline was administered and limitation of water intake was decreased and hyponatremia improvement was used. Yeast-like fungi was detected in the venous blood culture and in the cerebrospinal fluid (cell count: 252/3) CN-CD by India-ink preparation and bacteriological nature were determined. We made a diagnosis of sepsis and meningitis by CN-CD accompanied with SIADH. In spite of Miconazole administration intravenously and intrathecally, she died 2 months after admission. The minimal inhibitory concentration (micrograms/ml) of antibiotics against the isolated CN-CD was as follows: Amphotericin B: 0.78, 5-PC: 1.56, Miconazole less than or equal to 0.05, Nystatin: 25, Ketoconazole: 0.78.
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PMID:[A case of sepsis and meningitis due to capsule-deficient Cryptococcus neoformans with SIADH]. 269 39

The effect of breathing through inspiratory flow resistive loads ranging between 4.5 and 27.0 cm H2O/L/s was assessed in eight patients with amyotrophic lateral sclerosis (ALS) and in eight control subjects. ALS patients developed respiratory muscle fatigue manifested by significant declines in negative inspiratory pressure (18.3%), vital capacity (7.2%), and peak inspiratory flow rate (5.5%). Control subjects did not fatigue with these resistances. In ALS patients, theophylline increased respiratory muscle strength after resistive breathing as manifested by an increase in negative inspiratory pressure (28.2%), vital capacity (10%), and peak inspiratory flow rate (11.8%). It is concluded that in patients with ALS, the already weakened respiratory muscles are easily fatigued. Furthermore, theophylline can strengthen loaded respiratory muscles in patients with ALS.
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PMID:Effect of inspiratory resistance and theophylline on respiratory muscle strength in patients with amyotrophic lateral sclerosis. 272 51

The contemporary behavior analyst, to operate ethically and effectively, must be aware of many more factors affecting behavior than simple consequences. Although the literature demonstrating the effectiveness of active behavior management is impressive, a compelling argument can be made that a great number of behavior problem seen in individuals with developmental disabilities may be attributable to factors other than consequences. Our experience has been more often than not that physiological, organic, medication, or situational variables are the actual culprits in maladaptive behavior. Individuals with severe or profound retardation may respond to aversive features of their environment by displaying noncompliance, tantrums, aggression, or self-injurious behavior. These antecedents can affect their behavior just as powerfully as can the consequences of their behavior. Behavior analysts must become sensitive to these potential factors and be prepared to employ behavioral diagnostic strategies in the search for the causes of maladaptive behavior. Finally, they must be prepared to design rather unconventional passive behavior management treatment programs involving the manipulation of the antecedent environment. In the case of Carrie, from the example at the beginning of this paper, the analysis yielded the hypothesis that her face scratching was a reaction to sinus blockage caused by seasonal allergies. Her treatment involved daily dosages of antihistamines administered by our nurses and subsequent elimination of the scratching. Tom was found to be suffering from "wheelchair fatigue." When he was allowed to recline on other surfaces (e.g., bean bag chair, mat, bolster) on a regular basis, he did not attempt any form of self-injury. Melissa was found to have a severe case of Pre Menstrual Syndrome as well as seizure disorder, and was treated with the appropriate medications. Her headbanging was reduced to a few minor incidents per month. Walter's tantrums on closer inspection seemed part of a chain of behavior leading to seizure-like attacks. Preliminary evidence suggests that when he is treated with phenobarbital the tantrums and aggression disappear. And finally, Debbie was found to be very sensitive to a variety of discomforting events. She would cry, sob, and scream when she was wet, thirsty, hungry, and tired. Changing her regularly, offering her water every hour and extra snacks in the morning as well as short naps in the early afternoon eliminated the crying and sobbing. She now participates with the other clients and seems to enjoy the house activities.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Behavioral diagnostics. 274 44

1. Mechanical or electrical stimulation of isolated sections of body wall produced contractions that were graded with the intensity of the stimulus. Injury of body wall with shallow incisions produced extremely persistent contractions. 2. Long-lasting contraction of isolated body wall was also produced by brief application of "stimulated body wall wash" (SBW), sea water which was first washed through another section of body wall subjected to intense mechanical or electrical stimulation. Contractions were produced by SBW diluted to concentrations as low as 1% of the initial concentration. Contractions produced by prolonged application of SBW showed little fatigue, tachyphylaxis, or desensitization. 3. SBW caused contraction of isolated sections of body wall from all regions of the body, including tail, parapodia, siphon, purple gland, rhinophores, and anterior tentacles. SBW also caused contraction of isolated lateral columellar muscle and of the gill. 4. 30 mM CoCl2 blocked the release of contractile factors into electrically stimulated body wall and reduced but did not abolish contractile responses of unstimulated body wall to perfused SBW. SBW contractions were unchanged by disconnection of the perfused tissue to the CNS. 5. Hemolymph collected from the neck of an intact donor following strong electrical stimulation of the tail or excision of a parapodium ('stimulated hemolymphh, SHL) caused long-lasting contractions which were larger than those produced by control hemolymph (CHL) collected prior to stimulation of the donor. 6. Similarities between body wall contractions produced by SHL and by SBW, including their occurrence in 30 mM CoCl2, suggest that some of the contractile activity in SHL may be directly released from traumatized body wall. 7. SHL caused significantly greater cardioacceleration of the isolated heart than did CHL. Similarities between the cardioacceleration produced by SHL and by SBW suggest that a source of cardiac activity in SHL may be traumatized body wall. 8. SBW suppressed the gill-withdrawal reflex when applied selectively to the sheathed or desheathed abdominal ganglion. SBW-induced suppression was associated with significant reduction of evoked spike activity in identified gill motor neurons. SHL collected 1-2 h after noxious stimulation caused weak but significant suppression of the gill-withdrawal reflex when applied to the fully sheathed abdominal ganglion.
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PMID:Humoral factors released during trauma of Aplysia body wall. I. Body wall contraction, cardiac modulation, and central reflex suppression. 276 Feb 87

Pressure support ventilation (PSV) is a newer mode of ventilatory support that augments the patient's spontaneous inspirations to a preselected peak inspiratory pressure. We studied the effects of adding low levels of PSV (5 to 10 cm H2O) in conjunction with intermittent mandatory ventilation (IMV) on 15 patients who required mechanical ventilation for flail chest and pulmonary contusion. Patients were selected for the study if, during weaning from IMV, the following criteria were met: (1) a PaCO2 level greater than 45 mm Hg, (2) a spontaneous respiratory rate (RR) greater than 30 breaths per minute, (3) a minute ventilation (VE) greater than 9.0 L/min, and (4) spontaneous tidal volumes (VT) of less than 2 mL/kg. The PSV was added to the IMV at a level that augmented spontaneous VT to greater than 4 mL/kg. An average of 9 +/- 3 cm H2O of pressure support resulted in a fall in the level of PaCO2 (50 +/- 4 to 43 +/- 5 mm Hg), spontaneous RR (36 +/- 5 to 16 +/- 3 breaths per minute), VE (12 +/- 2 to 8.4 +/- 1.5 L/min), and dead space-tidal volume ratio from (0.68 +/- 0.1 to 0.47 +/- 0.05). Mean airway pressure and PaO2 both increased, but these changes were not statistically significant. Oxygen consumption was also unchanged. These results suggest that in patients who are difficult to wean due to respiratory muscle fatigue (characterized by increasing RR and decreasing VT), PSV normalizes lung volumes, improves ventilation, and may expedite the weaning process.
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PMID:Cardiopulmonary effects of pressure support ventilation. 277 10

We have previously shown that large inspired volumes can be achieved in phrenicotomized animals by intercostal/accessory muscle activation via spinal cord stimulation. In the present study, we evaluated the utility of this technique to provide complete ventilatory support for prolonged time periods (6 to 8 h, selected arbitrarily). In 10 deeply anesthetized dogs, a single electrode was introduced onto the epidural surface of the spinal cord and positioned at the T2-T3 spinal level. Bilateral phrenicotomy was performed in all animals to prevent possible diaphragm activation. The spinal cord was rhythmically stimulated approximately 13 times/min with trains of 15- to 20-Hz impulses of sufficient amplitude to achieve inspired volumes of 13 to 15 ml/kg and pressure-time index (product of duty cycle and delta P/Pmax) of less than 0.15 with each contraction. Level of alveolar ventilation was monitored by end-tidal PCO2 and intermittent arterial blood gas measurements. Mean inspired volume and minute ventilation were 236 +/- 7.84 (SE) ml and 3.12 +/- 0.13 (SE) L/min, respectively, and not significantly different between the first and sixth hours of continuous stimulation. Mean duty cycle (Ti/Ttot) was 0.26 +/- 0.01. Mean airway pressure (delta P) during prolonged electrical stimulation under conditions of airway occlusion was 8.05 +/- 0.61 (SE) cm H2O. Mean ratio of delta P/Pmax was 0.47 +/- 0.03 (SE) cm H2O; mean pressure-time index was 0.12 +/- 0.01 (SE). There was no evidence of system fatigue, as evidenced by the lack of any significant shift in the pressure frequency curve over a 6-h time period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Artificial ventilation by means of electrical activation of the intercostal/accessory muscles alone in anesthetized dogs. 278 46

The presence of a peripheral myopathy in hypothyroidism has been well recognized. Involvement of the diaphragm has been suggested recently but the clinical spectrum never clearly defined. We studied three patients with hypothyroidism presenting with fatigue, dyspnea, exercise limitation, and in two, chronic alveolar hypoventilation (PaCO2 of 51 and 75 mm Hg) before and after thyroid hormone replacement. In all patients diaphragmatic strength as determined by the maximal transdiaphragmatic pressure was low (2, 13, and 64 cm H2O) and improved with therapy (86, 84, and 90 cm H2O). Similarly, all patients manifested a fatiguing breathing pattern, as determined by the diaphragmatic tension time index. These values (0.22, 0.55, and 0.36) decreased after hormone replacement (0.16, 0.20, and 0.15). These changes were associated with the correction of hypercarbia in the two patients with hypoventilation and an improvement in lung volumes and exercise endurance in all patients. This study confirms that in patients with hypothyroidism diaphragmatic dysfunction occurs more frequently than has been suspected and might be of varying severity. This dysfunction reverses with adequate hormone replacement.
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PMID:Hypothyroidism. A reversible cause of diaphragmatic dysfunction. 280 37

Static fatigue of dental ceramics results from the interaction of residual tensile stress and an aqueous environment. This phenomenon is a potential cause of delayed crack formation and propagation in ceramic or metal-ceramic restorations. For dental ceramics, the influence of microstructural defects such as porosity or fissures caused by incomplete sintering is not known. The objectives of this study were to characterize the influence of porosity (produced by underfiring) on the crack propagation resistance of two feldspathic porcelains and to determine whether lower stress corrosion susceptibility or higher fracture toughness accounts for the superior thermal shock resistance of one of these ceramics. We underfired bars of each porcelain, 25 mm x 4 mm x 4 mm, by as much as 84 degrees C below their recommended firing temperatures. After polishing the specimens through 0.05 microns alumina, we induced cracks in their surfaces with a Vickers microhardness indenter. Semicircular cracks, which were produced under an applied indenter load of 19.6 N, grew with time during storage in distilled water at 37 degrees C. Underfiring of both ceramics caused a slight increase in fracture toughness and a relatively small change in pore volume fraction until we underfired the ceramics at 30 degrees C or more. The crack propagation data indicate that the higher thermal shock resistance of one of the ceramics--as measured previously by a water-quench technique-may be due to its greater resistance to stress corrosion at the initial stage of crack propagation.
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PMID:Effect of firing temperature and water exposure on crack propagation in unglazed porcelain. 280 66

The purpose of this project was to investigate and evaluate dental composite restorative materials classified according to filler particle size (microfill, small particle, hybrid) regarding fracture characteristics and susceptibility to stress corrosion. The composite materials were tested by cyclic fatigue in distilled water at 37 degrees C. No trend was observed between the number of cycles to fracture and the cycling load as a percentage of the modulus of rupture. Linear regression analysis correlation was weak for most of the composites used to determine the stress corrosion resistance constant, which ranged from 0.80 to 12.05. Observation of the fracture interface revealed inter- and intraparticle fracture for the small particle and hybrid composites. The microfills fractured between and through the prepolymerized particles.
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PMID:Cyclic fatigue of composite restorative materials. 280 53

Increased mobility of families and shorter hospital stays have added to the adjustment difficulties of new mothers, and lack of an adequate support system may cause the mother to end breast feeding. The purpose of this study was to identify the postpartum concerns of breast feeding mothers from time of discharge through the 1st postpartum month. The sample consisted of 32 women, aged 20-38, who had uncomplicated vaginal deliveries, were released from hospital by the 3rd day, and were breast feeding for the 1st time. They were telephoned daily during the 1st 2 weeks and twice a week for the 3rd and 4th week. 78% were primigravidas. 97% of the women reported a total of 210 concerns about the infant; 81% reported 237 concerns about themselves; and 19% reported 15 concerns about interactions with family or friends. Feeding-related concerns were most frequent in the 1st and 2nd weeks and included frequency of feeding (64%), formula and/or water supplementation, and duration of nursing time. Concerns about the infants' sleeping and crying behavior were also most frequent (76%) during the 1st 2 weeks. Sleeping concerns included the effects of long periods of wakefulness and sleeping during the day rather than at night. Crying or fussy behavior following feeding and during family dinner was reported by 53% of the mothers during the 1st week and 41% during the 2nd week. Concerns about the physical state of the infant included wellness and growth, temperature, cord care, bilirubin level, infection, and bowel movements. 81% of the mothers expressed concerns about themselves. Physical concerns included breast soreness, nipple pain and blisters, uterine bleeding and cramps, episiotomy pain, muscle pain, and hemorrhoids. 18 mothers reported emotional concerns, particularly fatigue. Only 6 mothers reported concern over interactions with family and friends, including lack of help from the father and pressure from visits by friends and relatives. The greatest number of concerns expressed in this study were related to the infant, whereas other studies have reported more maternal concerns. However, these women were all breast feeding, which may imply that they were more infant-oriented to begin with.
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PMID:Postpartum concerns of breastfeeding mothers. 283 23


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